Healthcare Provider Details

I. General information

NPI: 1437577236
Provider Name (Legal Business Name): NICHOLAS MCLAURY FORT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6262 SUNSET DR STE 301
SOUTH MIAMI FL
33143-4843
US

IV. Provider business mailing address

6262 SUNSET DR STE 301
SOUTH MIAMI FL
33143-4843
US

V. Phone/Fax

Practice location:
  • Phone: 305-209-5522
  • Fax: 305-443-9767
Mailing address:
  • Phone: 305-209-5522
  • Fax: 305-443-9767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME142062
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberME142062
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: